Diagnostic Radiology

Front 1

DIAGNOSIS: Dislocation of level C5 vertebra due to falling down stairs.

Back 1

Dislocation, Vertebra, C5 Closed, 839.05
Accidental Falls, other stairs or steps, E880.9

Front 2

PROCEDURE: Cross-table cervical spine x-rays, 3 views, revealed dislocation of level C5 vertebra due to falling down stairs.
Coded as if you work for the facility and no contrast, which means no physician.

Back 2

X-Ray
Spine 72020, 72090
Cervical 72040–72052
72040
Radiologic examination, spine, cervical; two or three views
TC
Technical Component
PROCEDURE: Cross-table cervical spine x-rays, 3 views, revealed dislocation of level C5 vertebra due to falling down stairs. 72040-TC

Hint 2

Radiologist: Facility claim where the radiologist has technicians doing the grunt work and the radiologist did the interpretation

Front 3

PROCEDURE: CT of the neck was obtained, which revealed no glottic or supraglottic masses. The only significant findings on CT were concentric (Having a common center or center point, as of circles) oropharyngeal and glottic narrowing.
Coded as if you work for the radiologist (The work is coded first, then the radiologist modifier)

Back 3

CT Scan
without contrast 70450
Neck 70490
70490
Computed tomography, soft tissue neck; without contrast material
Appendix A:
26
Professional Component
PROCEDURE: CT of the neck was obtained, which revealed no glottic or supraglottic masses. The only significant findings on CT were concentric oropharyngeal and glottic narrowing. 70490-26

Front 4

PROCEDURE: Percutaneous transluminal balloon angioplasty left renal artery supervision and interpretation

Back 4

Angioplasty
Transluminal
Arterial 75962–75968
75966
Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation
PROCEDURE: Percutaneous transluminal balloon angioplasty left renal artery supervision and interpretation. 75966-LT

Front 5

PROCEDURE: RADIOLOGY DATA: A 2 view x-ray of the right knee was taken in the clinic today, which was negative.
Coded as if you work for the facility:
“Remember both the facility and the worker have to get paid.” The work being done comes first, then the facility with the appropriate appended modifier.

Back 5

X-Ray
Knee 73560-73564, 73580
HCPCS Modifier:
TC
Technical Component
RT
Right side (used to identify procedures performed on the right side of the body)
PROCEDURE: RADIOLOGY DATA: A 2 view x-ray of the right knee was taken in the clinic today which was negative. 73560-TC-RT

Front 6

A patient had a left renal ultrasound today which showed no intrinsic renal disease.
Coded as if you work for the radiologist

Back 6

Ultrasound
Kidney 76770-76776
76775
Ultrasound, retroperitoneal (eg, renal, aorta, nodes, real time with image documentation) limited
26
Professional Component
LT
Left side (used to identify procedures performed on the left side of the body)
PROCEDURE: Renal ultrasound. 76775-26-LT

Hint 6

AMA Comment



You should report CPT code 76775, Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with image documentation; limited, if an ultrasound examination of a single organ (eg, kidney or urinary bladder) is performed. CPT code 76770, Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with image documentation; complete, would be reported if a complete ultrasound examination of the urinary tract (eg, kidneys, ureters, and urinary bladder) is performed

Front 7

PROCEDURE: Transrectal ultrasound-guided biopsy of the prostate supervision and interpretation

Back 7

Ultrasound
Guidance
Needle biopsy 43232, 43238, 43242, 45342, 45392, 76942
76942
Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation
PROCEDURE: Transrectal ultrasound-guided biopsy of the prostate supervision and interpretation. 76942

Front 8

Spinal is an abnormal narrowing (blank) of the spinal canal that may occur in any of the regions of the spine. This narrowing causes a restriction to ...

Back 8

stenosis

Front 9

DIAGNOSIS: Renal artery stenosis

Back 9

Stenosis, renal artery, 440.1

Front 10

A 50-year-old patient underwent placement of a non-tunneled central line under fluoroscopic guidance

Code just the no-tunnel central line

Back 10

Catheterization, Venous, Central Line, 36555–36556, 36568–36569, 36580, 36584

Front 11

A 50-year-old patient underwent placement of a non-tunneled central line under fluoroscopic guidance.

Code the Fluoroscopy

Back 11

Venous Access Device 77001

Front 12

PROCEDURE: Percutaneous right breast biopsy with mammographic guidance for needle placement.

Code the biopsy only

Back 12

Biopsy
Breast 19100–19103
19102
Biopsy of breast; percutaneous, needle core, using imaging guidance
(For imaging guidance performed in conjunction with 19102, 19103, see 76942, 77012, 77021, 77031, 77032)
Appendix A:
RT

Front 13

PROCEDURE: Percutaneous right breast biopsy with mammographic guidance for needle placement

Code the mammogram only.

Back 13

Mammogram
Breast
Localization Nodule 77032

Front 14

PROCEDURE: Percutaneous right breast biopsy with mammographic guidance for needle placement.

Back 14

PROCEDURE: Percutaneous breast biopsy with mammographic guidance for needle placement. 19102-RT, 77032-RT

Front 15

7. Placement of a tunneled central venous access devices, with a port using fluoroscopy in a 45-year-old patient

Back 15

Alphabetical Index → main term central venous catheter placement → sub-term insertion central 36555-36558
2. Numeric Section → code 36561 insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
3. Refer back to the guidelines under the heading Central Venous Access Procedures there is a statement referring to when imaging is used for these procedures. Two CPT codes are referenced in this statement 76937 and 77001. Always check the documentation to see if imaging was used.
4. Alphabetical Index → main term fluoroscopy → sub-term venous access device 36598, 77001
5. Numeric Section → code 77001 fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation; and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)

Front 16

Right greater trochanteric bursa injection and fluoroscopy for needle guidance.

Back 16

1. Alphabetical Index → main term injection → sub-term joint 20600-20610
2. Numeric Section → code 20610 arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial joint)
3. Notice under code 20610 the parenthetical note for imaging guidance when performed. The scenario states fluoroscopy needle guidance
4. Alphabetical Index → main term fluoroscopy → sub-term needle biopsy 77002
5. Numeric Section → code 77002 fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device

Hint 16

Knee arthrocentesis is a medical procedure that involves drawing excess fluid out of the knee joint with a needle. Also called knee joint aspiration, this is usually a straightforward procedure that can be performed on an outpatient basis, and does not require general anesthesia. A doctor may recommend knee arthrocentesis for patients who suffer from knee pain. Drawing out synovial fluid can relieve pressure on the joint, and it also serves as a diagnostic tool to determine the underlying cause of the knee condition.

Front 17

Pelvic ultrasound at 22 weeks gestation, limited study

Back 17

1.Alphabetical Index → main term ultrasound → sub-term pregnant uterus 76801-76817
Numeric Section → code 76815

Front 18

X-ray shoulder arthrography, supervision and interpretation only

Back 18

1. X-Ray, Shoulder, 73020-73030, 73050
2. 73040
X-ray shoulder arthrography, supervision and interpretation only 73040

Hint 18

Arthrography is a type of imaging procedure typically used to examine the interior structure of a joint, such as the knee or wrist. A contrast agent of some sort is generally injected into the joint before imaging, which helps the radiographer produce clear images of the interior structure of the joint so that doctors can fully evaluate the extent of any damage to the joint. Most people undergo arthrography when a joint injury is suspected. The procedure usually takes place on an outpatient basis. It normally involves the use of X-ray imaging, though magnetic resonance imaging (MRI) may also be used

Front 19

Pelvic ultrasound at 22 weeks gestation, limited study

Back 19

1. Ultrasound, 2. Pregnant Uterus, 3. 76801-76817
4. 76815 (quick look/limited)

Pelvic ultrasound at 22 weeks gestation, limited study (76815)

Front 20

Right greater trochanteric bursa injection and fluoroscopy for needle guidance

Back 20

1. Injection, Joint, 20610
2. Fluroroscopy, Needle Biopsy
3. 77002

Conclusion: 20610-RT, 77002

Front 21

Complete abdominal ultrasound with image documentation

Back 21

1. Ultrasound, Abdominal, 76700-76705,

Conclusion: 76700

Hint 21

An ultrasound is a procedure that uses high frequency sound waves, called ultrasonic waves, to produce images of internal organs and the interior of the body. This form of imaging works largely in the same way as sonar. Ultrasound images are often used in obstetrics but have non-obstetric uses including biopsies and echocardiographs. They can be used to produce either a still or moving image

Front 22

Epididymography, supervision and interpretation only

Back 22

Epididymography, 74440, Description is already described in this CPT

Front 23

X-ray of the forearm, anteroposterior (A/P) and lateral views (professional component).

Back 23

1. X-ray, Arm, Lower, 73090
2. Forearm is considered the lower arm
3. 73090 (views)
4. 26 professional
Conclusion: 73090-26

Front 24

Placement of a tunneled central venous access devices, with a port using fluoroscopy in a 45-year-old patient.

Back 24

1. Alphabetical Index → main term central venous catheter placement → sub-term insertion central 36555-36558
2. Numeric Section → code 36561 insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
3. Refer back to the guidelines under the heading Central Venous Access Procedures there is a statement referring to when imaging is used for these procedures. Two CPT codes are referenced in this statement 76937 and 77001. Always check the documentation to see if imaging was used.
4. Alphabetical Index → main term fluoroscopy → sub-term venous access device 36598, 77001
5. Numeric Section → code 77001 fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation; and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)

Front 25

Complete x-ray of internal auditory meati

Back 25

X-Ray, Auditory Meatus

Conclusion: 70134

Front 26

Hysterosonography with color flow Doppler, supervision and interpretation only

Back 26

Hysterosonography, See Ultrasound, Hysterosonography

Conclusion: 76831

Hint 26

If physician A performs the catheterization and introduction of saline or contrast and physician B is responsible for the radiologic supervision and interpretation of the study, then physician A would report his/her services with code 58340 and physician B would report the appropriate code for the radiologic supervision and interpretation (76831 or 74740).

Front 27

Chest x-ray four views, complete (technical component)

Back 27

X-Ray, Chest, 71010-71035, 4 views, 71030

Conclusion: 71030-TC

Front 28

Question is 53-year-old male for removal of 2 lesions located on his nose and lower lip.
Lesions were indentified and marked. Utilizing a 3-mm punch, a biopsy was taken of the
left supratip nasal area. The lower lip lesion of 4-mm in size was shaved to the level of
the superficial dermis. What are the codes for these procedures?

Back 28

Biopsy/Skin Lesion/ 11100-11101
2. 11100/distinct/unrelated or distinct
3. 11100-59 (separate distinct procedure)
1. Shaving/Skin Lesions/11300-11313
2. 11310 (Lips)
3. 11310-51(multiple procedures)

1. 11100-59, 11310-51